Birth Matters: A Midwife's Manifesta

Ina May Gaskin, the mother of modern-day midwifery in the United States, began her training over three decades ago. Thanks in part to her life’s work, a new corps of certified American midwives has been trained, and home births are increasingly available. But highly technical obstetrical practice is still the norm for hospital birth in America, despite a lack of evidence to justify it.

In Birth Matters: A Midwife’s Manifesta, Gaskin’s most recent book, she tracks our country’s tragic transition from a “wellness model” of midwife-attended birth, to an “illness model” of medicalized obstetrics, in which pregnancy and labor are subject to strict management and intervention. She writes about for-profit medicine, big business pharmaceuticals, and cites evidence about how under-researched drugs and protocols increase poor outcomes rather than prevent them. She notes that while obstetric technology can be life-saving, it can also be misused, and as long as the U.S. rate of cesareans continues to rise (it is nearly triple the 10 to 15 percent recommended by the World Health Organization), so will our dismal rate of maternal mortality.

Gaskin articulates our culture’s failure to understand the impact of mind-body connection as it relates to healthy, normal birthing. She marvels that this disconnect prevents us from appreciating how fear and adrenaline, both of which are heightened in the hospital setting, disrupt the delicate cocktail of natural hormones essential to coordinating effective contractions, cervical dilation, and birth.

The “midwife’s manifesta” of the title calls for woman-centered maternity care as a basic human right. Gaskin recommends a competent and compassionate system with effective division of roles, and checks and balances to enable midwives and obstetricians to work as partners toward the common goal of woman-centered birth. Rather than valuing sterility and convenience at the cost of normal birth, Gaskin aims for a new birth culture in which our understanding of physiology allows birth to be both a physical and spiritual encounter with the sacredness of life.

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